Description Alabama's Black Belt is a low-income, medically underserved rural region in the western portion of the state. Two-thirds of the area's residents are African American and are at considerable risk for diabetes, cancer, and heart disease.

Project collaborators continued their research on the Flying Sparks intervention, which used community health advisors (CHAs) to promote physical activity, healthy eating, smoking cessation, and health screenings to reduce risks of chronic diseases among area residents. Researchers attempted to determine the optimal level of PRC staff involvement during the implementation of the intervention: extensive, step-by-step assistance, or basic responses to requests for help. The researchers also tried to increase the communities' ability to address health issues and identify sources of community support that can contribute to intervention success.

PRC staff trained community facilitators from 19 communities and gave them structured guides and community health tool boxes (developed by PRC staff and community partners) that contained materials, activities, training videos, a cookbook, and five instructional manuals to help them recruit and train CHAs for the intervention. Assistants, separately recruited from the study communities and trained to administer the survey (indigenous interviewers), surveyed participating area residents at baseline and again after two years to assess health risks and level of available community support (social capital) among respondents.

The community facilitators were assigned to one of two groups: one that interacted extensively with PRC staff during the entire intervention process (Group 1), and another that interacted with the PRC only to request help (Group 2). Four communities were represented by members of Group 1, and 15 communities were represented in Group 2. The researchers set a goal of reaching 1,600 adult residents through CHA-led interventions and used survey results to compare health outcomes between groups.

During the study, 124 CHAs were trained from an initial group of 142 community participants in seven counties. At the start of the intervention, 1,387 residents completed health surveys and at two-year followup, 999 surveys were completed. The PRC researchers are analyzing the data, and in addition to learning about the health of community residents, the researchers will conduct a cost-benefit analysis to determine the level of PRC staff participation most effective in delivering the intervention in rural Alabama communities.